and the ship is struck by lightning and everybody has to pump until they make landful. the passengers have to take turns because the ship is filling with heart. so it is hard, it is hard to get around. it's hard to get around the united states. to go from new york city to albany, new york, if you took a hours, that would take you three days, on our own horse or a coach. if you took a boat up the hudson, that would take three days if the wind was right. if the wind was bad it could take you a couple -- ten days to in ifrom new york city toand ..ike, what, few hours. so, yes, there are restrictions that come from not being able to get around.
others about physics and the history of science and even a book on the brain. how did you come to write about organ transplantation and the death determination? >> guest: well, i wasn't drawn to organ transplantation at all, i was drawn to death. and the reason was i was watching carl say again on the charlie rose show with my wife several years ago in the 1990s, and he announced that he had had this, his second or third bone marrow transplant because of a cancerous disease he had and that it saved his life. he'd been saved by science. my wife looked and said, wow, he's going to die and soon. and he, i said, why do you think? she said, well, he looks bad and, second, this is the denial speech. she was in cancer support groups, and this is the speech you get out of people who are pronounced terminal, and they're in denial. it's just a classic denial speech. the show finished, and they announced that this had been a
rerun, that he had died. it had been taped a couple months earlier, and the man who had been saved by science was dead. and he had said an interesting thing in the show which was rose had asked him what do you think death is, is it the light at the end of the tunnel? he said, no, no, he scoffed at that. he said death is a long, dreamless sleep, quoting shakespeare. and i thought, well, that can't possibly be. i mean, sleep is kind of pleasant. you're breathing, your heart's beating, chemical processes are going on, it's invigorating. and this is one of the greatest skeptics of our age, and he thinks that he's just going to be sleeping. and he's, he's not going to be sleeping. he's going to be gone. so what i wanted to do was to try to find out what science said about death and what it was. and i started with a simple question which is how do we know when we're dead. and that ended up being the whole book because that's an
impossible question. >> host: it is a very difficult question. and i imagine particularly frustrating for someone whose whole professional life has been as a science writer and be someone, again, who's written a book about topics like physics where at least physics used to be pretty straightforward. granted, when you get into quantum issues, it's more uncertain. but i wanted to just start off before we get back to this great determination of death which, as you say, really is the essence of the book is a little bit more about you and your career, though, as not necessarily a man of science, but a writer of science, i suppose. [laughter] tell me about omni magazine and science digest and other places you've worked in. >> guest: well, i wouldn't say -- i really haven't had a career. i'm a blue collar guy who had a series of gigs and just followed whatever was happening and whoever would hire me and getting a new job whenever i was fired which was frequently. but i grew up in minnesota where
some strange magazines were created in the '30s. something called modern mechanics. there were all these futuristic magazines that came out of the world's fair of that era, i think 1932, and during the depression when people were so depressed just financially and emotionally, and these magazines talked about this great future. and i think i was inspired by that, and then inspired by sputnik when the country went through a vast educational transformation where the country was looking for people who were good at math who might somehow beat the russians in space. and i had the mask -- [inaudible] but not the really talent for it. so i never did do science, but when i got out of college, i was offered a job at a science magazine, and i took it. it's a wonderful thing to write about. >> host: and you went from there to co-authoring a book, "the god particle," which was a bestseller in 1993, right?
>> guest: i had a co-author. my co-author has a nobel prize, been on letterman. that was a bit of a help, yeah. >> host: how did you come to collaborate with him, and what was it like working with a nobel prize winner? >> guest: well, he was very funny. i'd interviewed him for the magazine, and he was always a big draw at physics meeting because he was funny, and he explained things so well. so i suggested we should do a book together, and we did. very easy man to work with and brilliant but in a really common man kind of way. >> host: ah. well, you mentioned humor, and, in fact, some of the reviews of that book said it was the funniest book about physics ever written -- >> guest: that's not a very high bar. [laughter] >> host: well, it's even a lower bar than a funny book about death which is what some of the reviews have said as well. >> guest: right. [laughter] >> host: what is the role of humor in your writing or the science writing in general? >> guest: well, i think for many
people they feel it shouldn't be a role. we were, letterman and i were criticized for being funny, that we brought down the field. i don't believe that. it's just a quirk of mind. i don't think science writing has to be funny or doesn't need to be -- or shouldn't be funny. it's just the way i happen to write. >> host: well, it was just striking that both books were, that humor was remarked upon in both of them. so in writing this book from one of the themes that seems to pervade is that it awakened in you or maybe reawakened things like a fair amount of anxiety about death. >> guest: yeah. >> host: say a little bit about -- >> guest: yeah. well, the first thing is that i really didn't think this out. if you think about it, you can't really study death totally scientifically because science is supposed to be empirical, supposed to be experiments. but death, part of the definition of death is that it's
irreversible, and it's forever. and so so when a person is dead, they can't come back and tell you it was like this. it's not like going to philadelphia, and they can come back and tell you about it. it's -- and if someone does come back, has a near death experience, well, then they weren't dead. because that's part of the definition. so i should have thought that out. but what we're reduced to studying are these sort of netherlands, you know, like netherworlds like brain death and persistent vegetative state, locked-in syndrome. and it was creepy. it was creepy reading about it and interviewing people about it. and so i started imagining myself in some of these states at times, you know, waking up in the morning sort of terrified and that trying to tell people i'm really alive in here, you know? like i was suffocating. i was very influenced by a group called the bell jar and the butterfly where the author was
in locked-in syndrome where you're totally conscious, but your brain stem is down, and you're paralyzed. here's a guy who wrote a book with one eyelid blinking out a letter at a time. and i had that book, i bought that book, and i sat around for three or four months before i was brave enough to read it. but it's beautiful -- that helped, actually, you know, that there was this incredible person inside this, inside this sort of shell of a body. >> host: yeah. it is, i remember learning about that in medical school, and we had, i had a patient with it once, and it is, it's a frightening -- >> guest: you had a patient? >> host: yeah, with that. >> guest: what was it like? >> host: uh, as i said, one can't help but imagine what this kind of thing would be like, and it sounds terrifying. um, back to you. >> guest: okay. [laughter] >> host: now, you worked in a hospice a bit. >> guest: yeah. >> host: i gather that's the past, you don't continue to do that. was that part of the research for that? >> guest: not really.
i was always interested, and it wasn't totally relevant to the book, or i didn't see it as relevant to the book. i just wanted to do it. hospice opened up a block and a half from my house, so i went down there, and they were happy to have me. because i was male. it's almost all, all the counselors are usually women. and there were, among 60 counselors they had only two of us were male. and i've always been interested in death. i wanted to see what these people were like. >> host: be what were they like -- and what were they like? >> guest: well, they actually have a spiritual counselor, a paid person who's not religious, but spiritual. because you're not allowed to challenge anyone's religious beliefs. and she made the comment once that for most people they die as they lived. and so it was lovely being with these people, but at the same time you could see that whatever insecurities they had they took with them to the grave.
if they were shy, they continued to be shy. if they were afraid of opposing authority, they would still be timid around the director. they would be, they could be bullied by staff in subtle ways and bullied by the volunteers in subtle ways. and so who you are is how you die is what i learned. there were moments. there were moments though. i did things i wasn't supposed to do, like you're not supposed to challenge people, and i had this one patient, let's call him biff for lack of a better name, and biff was always complaining about his wife who had left him and was not coming to see him in the hospice. and he would just go on every time to me about what an awful person. and finally i said, look, biff, you don't have much time left. you really want to go to the grave bitching about this woman?
and he said what do you suggest? i said, i suggest that you write a letter to her, and i will help you. he said, i don't know how to write. i said you will dictate it, and you will think of all the great things about her. and we will write it down. and you can either send it or not send it, but i think it might change your attitude if you tell me all these great things because i haven't heard anything great about her. so we did. it took a couple weeks, and we never, we never finished it because she came back to him. magically, she appeared one day at the hospice and became the devoted wife the last few weeks of his life. and i don't think there's anything like woo-woo going on, but later when he died, she found the letter that he had dictated to me among his belongings and called and thanked me very much because he had never expressed this to her in his lifetime. so it was against the rules, but i thought it was kind of a cool
thing to do. >> host: sounds very moving. indeed. now, denial of death, that's a big theme in this book. >> guest: yes. >> host: tell me about it, tell me about -- you have a whole chapter which i found so interesting about how, well, the universal nightmare, of course, is being very alive and how so many cultures have different ways of trying to prevent that from happening by trying to make it, building in mechanisms to distinguish the living from the dead over the millennia and across, so over history and across cultures. tell us some of the more memorable examples of that. >> guest: sure. well, only in the 18th century did, was death medicalized, as they say, where doctors came in charge of who was dead and who
was alive. up until then it was, like, well, you are a doctor, but regular old people decided when their next of kin were dead. and the egyptians, for example -- and the key, the quest was to find was there a singular organ that when it was gone meant the whole organism was gone, the controlling organism of the body. or was there a set of particular behaviors that would tell you this person's definitely gone. and the egyptians, for example, had no use for the brain. when they made mummies, they hollowed out the skull and threw this garbage away. they thought it was, well, what is it? they were very much concerned with the heart and the genitals. they would prop up the genitals in mummies. and the greeks would cut off a finger figures that was a pretty violet thing to do, and that would wake you up. the slaves in the eighth, tenth century, they would wash the body, make a lot of noise, and
then on the third day they would sing slavic folk songs which, i guess, if you don't stir for those, you're dead. and if they got no reaction after the singing, they would bury them. the pope has a very famous way of being determined to be dead, and that's with the camera lang go which is a cardinal-level post. and the pope hand picks this person, and this person decides when the pope is dead. he hits him three times in the head with a silver hammer and calls out his baptismal name three times which is carried over from the romans. the romans used that method, too, yelling your name at you three times. even today the pope isn't dead until the cammer lang go says he's dead. the doctors may pronounce him dead, but he has the final say. and it's a good system because, one, he's someone close to the pope, and, two, when he declares the pope dead, he's out of work so he's not likely to declare death prematurely.
the gold standard through the centuries, like, what is the thing we really are convinced when this happens, the guy's dead, is putrefaction. when you just smell to high heaven. and what this signals is cell death because the cell is the kind of atom of life, and when it's, when it implodes and gushes out, then you are probably dead if all your cells are dead. but it kept switching from the heart to the lungs to the brain, somewhere during the renaissance we see the brain come to the fore front as people believing it to be the determinant organ. and i think one thing my book doesn't go into because i'm just not qualified is i think this is, to figure out why this happened, you need an interdisciplinary approach. i mean, i think, i think decart had a lot to do with it. i think -- i think, therefore, i am. you see in shakespeare writing about we are the countercreation, we're the
noblest of beasts, that man is somehow different from other an malignants. so we started -- animals. so we started to have a definition of death that was lower, really, for humans because so much more was expected of us. we had these brilliant minds, and we're not dumb animals. therefore, when our mind goes and our brain goes, then we are gone because then we become like another animal. for example, with brain death no one ever talks about the brain death of a dog. the brain is considered unimportant in a dog. and it's not really scientific to say that, oh, there's this one species that's different. it's what we believe, perhaps, but it's unscientific to say that. and that's what we've come to today is we probably have the lowest standard for death in the history of man with brain death. >> host: and in some ways, the most contested because it's always an ethical conundrum and a metaphysical one, as you know, when a person becomes a body --
>> guest: yeah. and the -- what i found, you know, you mentioned that i'd covered particle physics. it's true, and i never heard particle physicists talking about their feelings. i feel that this is a proton. no one ever says that. they have tests for it, and they are physical tests. oh, i feel that was electron. no, and the medical profession talks very openly about its feeling. we feel that these reflexes and movements in brain dead people when they're being harvested for their orr gans, we feel that that is not pain, you know? we feel that's not important. as opposed to other sciences where they say, well, we have tests we did. we did a pet scan on this person, and while they were flailing around we showed no chemical, biochemical activity in the brain. we're not doing that. so we're just going on people's feelings. >> host: well, we'll get to that a little later. >> guest: okay. >> host: yeah, actually a very
controversial aspect of the book. um, and we'll certainly get to that. i wanted to move into technology because, um, you know, as you know new technologies probably in all areas but especially in medicine takes concepts and practices that seem to be settled and shifts them. >> guest: uh-huh. >> host: and in the case of organ donation and death determination, i understand that was really your overarching interest and the organs are secondary, but that that technology happens to be the ventilator. >> guest: yes. >> host: would you agree? >> guest: yes, yes. and the -- it starts with william harvey, the english doctor who charted the circulatory system. he was wondering about what's the pivotal organ. and he chopped off the head of a rooster. and he had his own ventilator
which is a chimney bell close. and he stuck it in the windpipe and pushed air into the rooster's lungs, and it revived the rooster. he could keep this rooster alive without his head. and then in 1903cushing, an american surgeon, thought is a person with fatal brain damage r they alive or dead? so he gave one of his patients artificial respiration, old-fashioned, you know, push on the back, pull the elbows up respiration, and he was able to keep one patient alive for 23 days this way. the heart continued to beat while he gave him artificial respiration. and then in the '40s and '50s a remarkable thing happened was the polio epidemic. and the iron lung is, basically, a protoventilateer. in many ways it's a better ventilator than ventilators we had later. but we were keeping, obviously, thousands -- there were entire
floors of hospitals devoted to iron lungs and kids who would otherwise die without them in them. and then the ventilator we know today which is a much simpler mechanism, less bulky, rather, came about. and we had all these people in icus being kept alive, and at that time -- not today, but in that time they were crowding up the icus. and so this pushed a group of people to form the harvard ad hoc committee on brain death to come up with this new, new definition of death. >> host: and we'll come back to that as well, right? but right now who are the undead? that's the title of your book, who are the undead? >> guest: i'd say it would include the brain dead, it would include people in persistent vegetative state or pvs, it would include locked-in syndrome, it would include some mentally conscious people, those who are having near-death
experience. those are the people that i looked into that gets get as clo death as you can get without dying. and be, of course -- and, of course, the organ transplant establishment would say that brain dead people have not gotten close, they are dead. and that's where we disagree. >> host: and how do they make that determine nation? >> guest: which one, of brain death? >> host: brain death. >> guest: the original harvard payer in 1968 said there should be no reflexes and no movement, and the breathing, whether a person could breathe on his own was decided by an apnea test, it's called the apnea test which the ventilator is turned off, and then you see if the patient can breathe on his own. if he can't, then he's dead, and you repeat all of these tests anywhere from two hours to 12 hours later. the clinical side of the test looking for reflexes and
movement, it involves squirting ice water in the ears with reaction, touching the cornea with a q-tip, putting a flash light in the eyes, turning the head sideways to look for doll's eyes. if you're alive, it takes a while for your eyes to adjust to the movement. but if they're doll's eyes, they go directly sideways when you move the head sideways. it's a very short exam. i just noted from the time of the transcript that we had is that it was much shorter than my last eye exam. and then there's the apnea test. now, originally the harvard committee said there should be confirmatory tests because these tests only test the brain stem. the stalk at the base of the brain. it doesn't test the cortex which is what most of us think of as our brain, it's where we think, it's where we feel, where we feel pain, where we feel pleasure, it's where we see things, hear things. so they should put a, take an
eeg of the patient to see if there are any brain waves. and that's been eliminated. these confirmatory tests have actually decreased through the years, not increased. and as more technology has been developed, it has not been used. for example, pet scans were used in england on pvs, persistent vegetative state, patients to see if they were really unconscious. the vegetative patient, his brain stem unlike a brain dead patient, is working -- >> host: terry schiavo. >> guest: probably not the best. she probably was not there from what the autopsies are telling us. i haven't followed it that closely, but the brain stem is functioning, you can breathe on your own, but the rest of the brain is gone, and you have no consciousness. it's, it's estimated there's something like 100,000 people in pvs in this country alone, and
the tests for pvs were devised in the 1970s by a man named fred plum who was sonny van bouloute's doctor, and he said you don't need technology or equipment, just do these things. and a lot of it had to do with examination of the eyes and reflexes. when they put pet scans on these people in england, a doctor named aide ran owen, he found that 43% of them were conscious. these were people we had judged to be unconscious. someone had been in this state for four years. and be he devised ways of communicating with them through hand buzzers, and some of them he brought back to consciousness. and for years the families of these patients had said, you know, our son or my husband, whatever, seems very aware when people he likes come in the room, he brightens up. and the doctor, there's a doctor he likes, there's a doctor he doesn't like, and you could tell from his expression. and this had all been
pooh-poohed, and aide ran owen listened to these people. and with this technology he found they were conscious. and another thing is called functional mri which does an mri in realtime. it just doesn't take pictures, it's ongoing like a film almost, and that can detect consciousness. but we're not using this technology to ferret out the people who aren't really brain dead. um, well, yeah. my impression that mentally conscious state is certainly different from the persistent vegetative state. >> guest: yes. >> host: yeah. but you're making, you've taken that distinction into account in this, in that example -- >> guest: oh, yeah. it's a much less, it's much less closer to death than pvs, yes. >> host: right. and that is where people often come out of that, and that's my understanding where, um, an mri
has been used experimentally, where people are asked to imagine yourself playing tennis, and there is activity. >> guest: right. >> host: and this is introduced, again, technology introducing a whole other wrinkle into these kinds of determinations. >> guest: but you should know, though, that this technology is not used to test brain death. >> host: but that's true, it's not used to test brain death -- >> guest: there, we're not even going back to eeg. >> host: right, and for reasons that we're going to -- >> guest: okay. >> host: -- come to, but that's a very important point, and i know you emphasize that a lot in the book. well, if you don't -- several times you've mentioned you don't think, this is too important to be left to physicians, this determination, who -- if i'm understanding you correctly, but who would you leave it to, or how do you, what kind of a process do you feel would be more appropriate? >> guest: well, i think it was phillip roth who said, you know, you're on an airplane, and the captain comes over the intercom
and says we have an emergency, is there a doctor on the plane, and he noted that you never hear is there a writer on the plane because we would just tell you that the wing's on fire and then go back to our drink. i don't have any practical advice about what to do about it, you know? i am a, i'm, you know, i'm not a wonk. anything i would, any plan i would come up with would be so fatally flawed as to be worthless, so i don't know what you do, but i just simply point out that for most of human history people have not left it to doctors. what we've got now -- since 1981 there was a law passed called the udda, the uniform determination of death act. and it's now law in all 50 states. and what it says is there are two forms of death now. there's regular old heart and
lung death, and there's brain death, and they're both legitimate. and there's only one kind of person who can decide who's dead, and that's a doctor. and that doctor cannot be faulted. he cannot be arrested, charged criminally for saying someone two's alive is actually dead, and he cannot be sued civilly in court for making a mistake. so not only have doctors totally taken over this area, but they have no responsibility either. >> host: well, we have responsibilities when they mess up, that's for sure. remember that case last, within the last two years in california of a surgeon who, um, was examined for potentially prematurely taking organs from a patient who might not have been fully dead, do you recall that? obviously, you wrote this book before --
>> guest: was he arrested? >> host: he was investigated. he was not arrested, but people take it very seriously, i guess that's, that's the point. >> guest: was the, were the patients declared dead? >> host: yes. this was a, well, this was a case of non, of circulatory death as opposed to brain death or obtaining organs. >> guest: oh, okay. >> host: actually, can you say more about the general requirements for obtaining organs or at least the official ones? i know you're skeptical that they're often met, these thresholds and requirements. >> guest: well, we have what's called the dead donor rule which isn't universal, as you know. there are live donors for kidneys -- >> host: oh, of course. >> guest: but that's the only organ we get from live donors. if you have two kidneys, you can get along without one. but everything else comes from a dead donor, and there are two kinds of dead donors.
one is brain dead, that we've spoken of, and they have beginning in the last 15 years start taking organs more often from those who die in conventional means, you know, heart and lung. and that's a very -- some doctors think that's even scarier than the brain dead because you have to wait for the person's heart to stop. and then immediately transplant it before, before it spoils, layman's terms. there's a very short time window. and be all sorts -- and all sorts of gimmicks are used such as cushion, sort of baffles sort of like a blood pressure cuff are put around the donor to keep the blood pressure going after his heart's stopped. you know, to keep the organs artificially profused. sometimes chemicals are injected. and the problem you're waiting for a man to have a heart attack or a woman to have a heart attack, and what happened in the
real world is a person has a heart attack, and you try to resuscitate them. they don't try. and, and in some ways it's called the two minute drill because after the heart's stopped, you wait two minutes and then you harvest. some people wait three minutes, some people wait five minutes. but in any case, people's hearts have been started long after five minutes. >> host: families give permission for this, correct? >> guest: yes. yes. well, yes be no. it's an interesting point. that's the debate. with new laws where you're checking it off as a donor on your driver's license, that is theoretically binding in all 50 states, and even if your next of kin's saying, no, we don't want this to happen, the doctors can still do it. they don't like to. if family puts up an objection, they worry about it, and they
try to quell the family's fears. but if you are used to the brain dead type of donor and you -- that's what you're thinking of when you, if you're thinking at all when you check off that box, are you thinking that you're going to go through this new process of where you're a what's called a nonbeating heart cadaver where they're waiting for your heart to stop before they harvest you? >> host: i believe they need to interview the family before they do that. that's my impression. >> guest: well, now, a legal expert in the field, they're thinking maybe they don't. that's the debate. do they really have to do that? because that might cut down the number of organs. this method is really not new, it's what christian warren argues. >> host: that's true. they used it in 1968. >> guest: yeah. they used it in '67 with the first heart transplant, and the
problem this was that i think her name was darnell, delaware neat. i think denise ann darnell. she was the donor, and her heart wouldn't stop. they had a recipient waiting, and her heart just kept beating. and the brother years later admitted they injected some potassium to temporarily stop the heart so they could declare her dead so they could remove the heart and put it in somewhere else. it's illegal today. you have to have two different teams, a team that declares death and a separate team that does the harvest and transplantation. >> host: i'm glad you said that. that firewall is incredibly important. and people who are reluctant to sign their organ donor card, that's one of the main reasons. they're not going to take care of me, oh, yes. the doctors aren't going to save me if they know you're a donor.
>> guest: it's actually the opposite. you may get the best care of your life if they think you're a donor. and that's another controversy, can you give patients drugs that are only meant to keep their organs healthy but have no benefit to the patient? in other words, are you already treating them as a bag of organs before you declare them brain dead, or are you treating them as a patient? and, of course, after you've been declared brain dead, you will get superb treatment because -- well, frankly, brain dead people are biologically alive in my opinion and in the opinion of many people because they hook them back up to the ventilator, their hearts continue to beat, they can get infections, their immune systems will fight the the infections, they have heart attacks. and they can be resuscitated. yoil see -- you'll see crash carts going down hallways to resuscitate a dead person.
they get bed sores. the language in the journals is very interesting because one of them warns people, the nurses taking care of what they call beating-heart cadavers, a brain dead person awaiting harvest, they said be careful because diabetes and syphilis is one of the comely cases of death. complications of death. usually when people die, you don't worry about complications. and there was a 2008 white paper report from the president's council on bioethics that said that some, some dead people are less healthy than others. you know, i don't -- to me, death should be binary. there shouldn't be some really healthy dead people and less healthy dead people. they should just all be dead. >> host: well, that's where brain -- when a person is declared brain dead, um, it's just, let's just go over this,
their cortex is, their cortex which is, as you said, the consciousness, the engine of consciousness and perception of pain and what makes us human, recognizably human, think and feel, and then there's the brain stem which controls the breathing and other basic functions and those reflexes. and as you said, those are what are tested for in brain death determination. but they can be, an eeg, for example, which you seem to be saying you believe should still be used? i'm under the impression you believe that. >> guest: it's not a very good test, you know? and be as brain death advocates rightly point out, it's artifact meaning artificial waves that may be -- there's a lot of equipment in the hospital. it may be picking that up. but you get the other results, too, where you'll see an almost
flat brain wave where the person's alive. they've put them on living people, and 10% have come out with flat brain waves. it's not a good test. and there are waves in the interior of the brain that it's not going to pick up on the scalp. so it's not a good test. but we have other tests. the thing is, the reason they don't do eegs is because the clinical part of the harvard criteria, you know, the water in the ear and the flash light and turning the head and the reflex and then the apnea test, those are called the clinical parts of the test. when they were based on no patients at all. the harvard committee looked at no patients at all and cited no medical papers, no scientific papers. they just spun this out, these criteria. so there were two groups after that in the late '60s and '70 that decided to look at actual patients who had passed the
clinical definition of death to see if they were truly dead by doing autopsies, etc. and they found that doing autopsies on the brain dead who were past brain death, the clinical criteria, many of them their brains had not been self-destructed. they didn't look dead at all. and when they put eegs on some of them, remarkable number of, you know, minority, but five out of nine in one case, they tested nine, five out of nine still had eegs before they died. and another was less scary, it was 17 out of 503 had brain waves after they'd been declared brain dead. but it should be zero. >> host: well, actually, you're making, um, a good point and one that, um, i wonder might have been a little obscured in the book because i came away from
the book and also that article you wrote in the "wall street journal" which was that eeg was abandoned, um, irresponsibly -- >> guest: well, it was. >> host: oh. well -- [laughter] then i'll just, actually, i have, i just want to elaborate a tiny bit on what you just said about the fact that you can get these false positives and false negatives. >> guest: yes. >> host: and that's the very reason why it was abandoned -- >> guest: i don't think so. i didn't want see them saying that. they're saying that now. they're saying that after the fact, but they said that in 1969 to 1972, they weren't getting dead people, you know? they were saying we're getting -- because we got some of these tests, the tests must be wrong. >> host: but -- >> guest: and they threw it out. they just threw it out. they didn't add something. you should add something. they say, well, if you think the eeg is flawed -- and it is -- then what are you going to do to confirm that the upper brain is
dead? and their decision was to let's do nothing. >> host: well, that actually gets to the american academy of neurology. now, one of the questions i had was that, you know, the 1968 and now brain death determination is done somewhat differently as you say, and the eeg is not part of it because there are so many situations. for example, you can be on medications that can give you what's called a flatline sometimes or even hypothermia, if you've been pulled out of, you know, these kinds of things. >> guest: not just a flat line, you can pass all the clinical tests for brain death also. >> host: and be, -- and, um, may other reasons. i've got this from a textbook, and the point is, and can you note, there are many reasons why
someone could have an eeg that looks deceptively active or inactive. but that was, you know, 1968. clearly, much has happened, new data are accumulated and new technologies will come online, and the american academy of neurology really does set the standards for brain death determination, has issued guidelines in 995 and 2010 -- 1995 and 2010, and i wondered how come those weren't mentioned in the book? >> guest: well, they're hardly different. there has -- as you say, there has been a lot of technology added since 1968. and the writers of that article were saying as new technology comes along, we hope it'll be adopted for testing the cerebral cortex. so you tell me how much of that technology has been adopted. what's called the aan -- >> host: american academy of neurology. >> guest: yeah. well, first of all, they're
neurologists. and an interesting thing is that the harvard committee had 13 men on it, 12 of them were doctors. not one -- there were mostly neurologists, a couple of transplant people including joseph murray who won the nobel prize for transplant, and they came out and said that brain death is exactly the same as heart-lung death. but they had no cardiologists to tell them that. they didn't let any cardiologists on the committee, nor did they have any pull nonologist. they had no one to say, oh, yeah, this is exactly the same. because i don't think they believe that. and can they set up rigorous tests that they have now been abandoning. the new tests are just -- kind of like rearranging deck chairs on the titanic. >> host: let me just read --
>> guest: go ahead. >> host: -- one thing from the academy of neurology because we can take it out of the realm of the abstract and what, and take it into the ultimate empirical dimension which is does anybody, has any patient who's ever been declared brain dead by the american academy of neurology standards which are similar to the ones you've mentioned without the eeg, has any of them ever awakened? and in this 2010 report, they actually, it's called evidence-based guidelines, an update on determining brain death in adults. and the objective of this report specifically was to update their 1995 guidelines with respect to several questions, but the one that's most relevant now is are patients who fulfill the criteria for brain death, did they ever recover neurological function? and they did an extensive review, and their finding was,
no. to me, that would be kind of the ultimate empirical test. >> guest: well, how are they going to recover when you take their organs out of them? >> host: oh, this doesn't necessarily have to do with organs, this is brain death criteria. >> guest: but people who are pronounced brain dead? >> host: oh, it doesn't have to be just -- i mean, not everyone, certainly, you know, and as you, um, in fact, the conversion rate, what the conversion rate refers to -- >> guest: right. >> host: yeah. you note correctly that very few people die by brain -- >> guest: 1-2% be. >> host: yeah, probably 1% be. >> guest: are they saying 1%? >> host: yeah, less than 1%. and then not all of those bequeath their organs. the families are, um, depending on whether they know the person's wishes are often as likely as not to donate. but, um, but i just bring that up as another perspective on -- >> guest: well, this has been
said every year since 1968, that no one has ever survived brain death. this has been said every year -- >> host: well, i'm more reassured that we're saying it in 2010. >> guest: well, 2010. have you read shuman's report? the other thing they're saying is these people will die quickly. they will quickly go to cardiopull my their death, correct? >> host: it depends how they manage them in the hospital. sometimes they can last months as you note in your book. >> guest: twenty years. >> host: that i'm not familiar with. >> guest: twenty years. before the -- the president's council on bioethics actually accepted -- >> host: yeah. >> guest: -- shoeman's paper as true. and he pointed out there were 150 cases as opposed to zero where people did survive longer than the week. well, you know, when brain death first was promoted they said a
couple hours to a day. if you're brain dead, you put your back on the ventilator, you've got very little time before you go directly to your heart stops beating. >> host: okay, fair enough, there's variation in time. >> guest: variation? twenty years. >> host: what about the quality of life? >> guest: yeah. >> host: that was not something, and some of the folks who reviewed the book noticed that -- i mean, you can't cover everything in a book, i appreciate that. but what about the quality of life? even if you are brain dead and you survive, let's say, 20 years on a respirator, i mean, that's an ethical question again about when one disconnects that. but there is a quality of life dimension, and that's something that wondered if you had comments on that because not that much on that in the book. >> guest: there's nothing. i don't think there's anything on it. it wasn't my concern. i was trying to answer this question, when is a person dead.
not should they be kept alive forever. i wasn't making any moral judgments on whether they should be kept alive forever. i don't think i would want to be. >> host: yeah. >> guest: but could they? is this really death? i mean, the quality, you know, i think -- i have a wife who's a freelance writer, and i think most people would say i would rather be unplugged than have your life and the insecurity of it. yet i've decided that i would go on and not unplug myself. i can't make those decisions. what i was trying to say, is this death? i mean, as soon as you go through buickerty, you could say, well, you're on a slippery slope to death. as soon as you're born you're on a slippery slope to death. not is this life worth it or not worth it, i'm just saying is this person dead or not dead, and i don't really see where brain dead people are dead. now, the president's council wants to push it a step further. they want to, they want to harvest the hundred thousand
plus people who are in persistent vegetative state. they don't think their lives are worth living east, and they want -- either, and they want to -- >> host: my gosh, not president bush's council. dr. leon kass and pellegrino. as you said, they felt that neurological standards were valid. it's a 100-page report, and i'm sure you know it well, although you must have finished the book before -- >> guest: what year is this? >> host: 2008. the president's council. >> guest: no, i read that. now, in that, if you read that carefully, they suggest that the persistent vegetative state person could be harvested. >> host: well, what i think -- the way i read it was they were trying to almost adjudicate between people who thought the threshold was too high and those who thought it was too low. like those who thought maybe somebody like an encephalic individual, infants, you know, that's very debatable. there's no question about that. that that might be appropriate
candidates and others who felt, in fact, that we might even return to the cardiovascular standard. so they really had to adjudicate a lot of -- and most of the people on that commission were not, were bioethicists and folks not directly involved with transplantation which is a little different from -- >> guest: but they did say -- >> host: they talked about the debate, for sure. >> guest: no, they, their decision -- they made recommendations in how you would harvest a pvs patient. they said that we don't want to freak out the transplant surgeons, the retrieval surgeons because these people's eyes would be open, and they would be breathing. and so they said we really have to give these donors sedatives so as not to upset the doctors. i'll find you the reference, but that's true. >> host: let's move on to you. i notice that we're, we're moving along -- >> guest: oh, okay. >> host: we only have about ten minutes. now, you mentioned in here you
have diabetes. >> guest: yeah. >> host: and that's, as you know, one of the bigger risk factors for, ultimately, developing renal failure. i'm not saying you will, but statistically over half, about half of all folks who ultimately need kidneys in this country, the it's because of renal, excuse me, diabetes. if you did need, if you did need a kidney, what would, what would you do? would you opt for dialysis or accept a deceased kidney? have you thought about that? >> guest: probably just fold my cards. i mean, i'm 66. if i were 0 -- >> host: look at you, you're feisty as can be. >> guest: but, i mean, i'm 66. i've outlived my evolutionary usefulness by double. i just, you know, we just live in a society that is so entitled, i don't believe i'm entitled to more years. i've had a good life. this is good. >> host: okay. okay.
um, you had, actually, you have a nice few pages in here about, um, the -- you said not so much the pitfalls of avoiding death, but of that time you have between now and death. and there were things that, um, that you thought one should do or at least you should do. talk a little bit about that? >> guest: yeah. well, yeah. [laughter] i have some mundane examples. this sounds pretty silly, but we waste so much time in our lives, and i'm just sort of, like, don't want to waste anymore time. like, i don't go to weddings. [laughter] you know, they don't work out. and whether they work out or not, i realize it's probably not dependent on my attendance or nonattendance. i had this funny conversation with my roofer, you know, when i was 60, i put a new roof on, and he said do you want 30-year shingles, for a few dollars more
i can get you 40-year shingles. and i said, well, that would be odd. that means i can either choose between the shingles that will last 15 years after i'm dead or 25 years after i'm dead. why would i possibly care? and he said, well, that's a funny way to think about it. i said, no, it's perfectly reasonable way to think of it. so it's changed my way of thinking that things are temporal, i don't want to waste the time. i don't want to do things i don't want to do. i want to get things done that i haven't dope. done. there's just people's worries now just amuse me. and, you know, i'm in a position, i'm 66, i'm living on borrowed time. i've avoided the pitfalls of life. just have a good time. >> host: sounds like this was a therapeutic exercise for you. you start out so anxious about death, and now you're much -- sounds like you're more philosophical and distanced from
it. >> guest: well, people say i seem more relaxed, and i explain to them it's because we're going to die. you haven't talked about your kidney. >> host: that's because this is about you. >> guest: i thought they brought you in here because you had -- >> host: oh, well, that got me interested in this topic, and i'm very interest inside the shortage, certainly -- >> guest: but yours is a live donor. that's very different. >> host: it is. and those are the donors i'd like to see more of. >> guest: do you -- are you close to your donor? >> host: i'm quite -- i'm much closer to her now than i was. we weren't even that close. she came from a third party. it was, it really leaves you speechless with gratitude, it was an amazing thing she did. >> host: what was her reason for doing it? >> host: she's a fine -- >> guest: but she knew you, right? >> host: she did know me. but, and i am more than happy to talk with you about this after because i've become very passionate about increasing living donation.
i even think we might compensate people for their organs, but that's a whole other issue. um, what i want to know from you is you've written a supercontroversial book. i don't believe your others have been this controversial, right? >> guest: my previous one about non-white science was. that got me a lot of -- >> host: non-white? >> guest: well, it was non-western, and that usually means non-white. the debt we owe to ancient non-white, non-western cultures. that got a lot of -- you know, who weren't necessarily white, you know? >> host: uh-huh. when did you write that book? >> guest: then years ago. >> host: so it's been a whole decade without a lot of controversy. >> guest: well, right. i got a lot of hate mail on that. >> host: you got a lot of pushback. >> guest: i prefer hate mail. it's more dramatic, don't you think? if you're a journalist, you live for that. [laughter] we can't do anything positive for the world, as i mentioned, but we can upset people.
and and that's always a pleasure. >> host: and stimulate -- >> guest: that's another way of putting it. >> guest: and healthy keptism. for a science writer, that's very important. what's next for you? >> guest: you know what? i want to do a big book about puppies and kittens. [laughter] and how adorable -- >> host: i think you're kidding. >> guest: how adorable they are and see if i get as much hate mail on that. you know, i like to stay out of the, stay out of the vortex for a while. >> host: so, mr. teresi, it's very interesting to talk to you about the book whose full title is "the undead" -- it's a long title. "organ harvesting, the ice water test, beating heart cadavers -- how medicine is blurring the line between life and death." taking it on out of passion. nice meeting you. >> guest: thank you.
>> that was "after words," booktv's signature program in which authors of the latest nonfiction books are interviewed by journalists, public policymakers, legislators and others familiar with their material. "after words" airs every weekend on booktv at 10 p.m. on saturday, 12 and 9 p.m. on sunday and 12 a.m. on monday. you can also watch "after words" online. go to booktv.org and click on "after words" in the book series list on the upper right side of the page. >> it's been nearly ten years since the release of robert care row's third volume of the years of lyndon johnson. and in just a few weeks the fourth volume will be published. it follows 1982's the path to
follow. here he is on "q&a" in 2008 with an update on how volume four was taking shape. >> this is really a book not just about lyndon johnson, but about robert kennedy and jack kennedy and the interplay of their personalities, particularly robert, i guess. and it's a very complicated story that i don't think people know of two very complicated people. and -- robert kennedy and lyndon johnson. and i had to really go into that and try to explain it because it is part of the story all the way through the end of johnson's presidency. that's done, and i suppose chronologically at the moment johnson is passing the 1965 voting rights act. and can that's sort of one way where i'm up to now. >> watch the rest of this interview and other appearances by robert caro online at the c-span video library. and watch for our upcoming "q&a"
interview with robert caro on sunday, may 6th. here's a look at some of the upcoming book fairs and festivals that are happening across the country. on april 14th the university of california irvine will host the sixth annual literary orange. the festival will feature paula mcclain and lisa c.. the sixth annual philadelphia book festival will be held april 16th through the 21st, key speakers include sonia sanchez and robert poe lee toe. and then on the 21st and 22nd, booktv will be live from the los angeles times festival of books at the university of southern california. we'll interview several authors including karim abdul-jabbar. we'll also be covering various author panels on topics ranging from internet security to the port huron statement. and we'll be taking viewer phone calls, e-mails and